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Identifying Dental Deserts in the Los Angeles County Safety Net using GIS Maps
Maritza Cabezas, DDS, MPHDental Director
Oral Health Program
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Background:
• Los Angeles County is the most populous and most diverse county in the US.
• How can issues related to access to dental care be addressed based on data and facts in such a complex system?
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Q: How can someone plan for dentalexpansion in this vast and complex environment?
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Facts About Los Angeles County:• LA County:
– Population: estimated to be more than 10 million– The most populous and most diverse county in the US– Size: 4,058 square miles– The county is larger than the combined areas of the states of Rhode Island and Delaware
• Cities in Los Angeles County:– There are 88 cities in LA County – LA City is the 2nd most populous city in the United States (New York City is the most, but consists of 5 boroughs/counties)
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‐ Approximately 10% of county residents live outsideof the 88 cities in unincorporated areas (137)
‐ The population of Los Angeles County is larger than 41 of the 50 states.
‐ More that 25% of California residents live in LAC
‐ Population density is very high: 2,420 people per square mile
‐ Los Angeles County has the highest number of millionaires and the largest number of homeless people of any county in the US
Facts About Los Angeles County:
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Q: How can someone plan for dentalexpansion in this vast and complex environment?
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Answer: Using a Geographic Information System (GIS) Map with applicable Data sets.
The Power of Mapping:GIS lets us visualize, question, analyze, and interpret data to understand relationships, patterns, and trends.
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Objectives:• Show how this complex system of dental care delivery can be analyzed by using GIS maps
• Define Dental Deserts (DD)• Illustrated the steps used to identify the Dental Deserts
• Demonstrate how GIS helped with the identification of Dental Deserts
• Discuss next steps
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Demographics:
Who utilizes LAC DHS Dental Clinics?
Who are our patients?
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Patient Demographics: GENDERNumber of Patients (FY 2012-13)
Gender Number Percent
Female 16,513 55.8Male 13,060 44.2Unknown 2 0.0
TOTAL 29,575 100.0
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Patient Demographics: AGENumber of Patients (FY 2012-13)
Age Group
Number Percent
0-107 122 0.4
5-14 753 2.6
15-17 609 2.1
18-24 2,310 7.8
25-34 4,589 15.5
35-44 5,189 17.6
45-54 7,094 24.0
55-64 6,919 23.4
65+ 1,990 6.7
TOTAL 29,575 100.0
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Slide 12
NB2 WHy did you decide to break up the pie chart into the 4 age groups? is that based on something?Noel Barakat, 3/16/2016
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Patient Demographics: RACE/ETHNICITYNumber of Patients (FY 2012-13)
Race/Ethnicity Number Percent
Hispanic 18,956 64.1
Black 5,892 19.9
White 2,242 7.6
Asian/Pi 1,151 3.9
Native American 71 0.2
Other/Unknown 1,263 4.3
TOTAL 29,575 100.0
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NB6
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Slide 13
NB6 if you can do it easily, I think it would help to have the color coding on the table match the color coding of the pie chart. but its not a big deal if it is too cumbersome to do.Noel Barakat, 3/16/2016
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Patient Demographics: Patients by Service Planning Area (SPA)
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Types of Dental Clinics Included in Map:
1. My Health LA (MHLA) Clinics2. Comprehensive Health Centers (CHC)3. Graduate Medical/Dental Education Institutions4. Federally Qualified Health Centers (FQHCs)5. Community Clinics6. Dental Schools7. School Based Clinics8. Clinics that treat only HIV patients9. Clinics that treat only Children
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Initial Data and First GIS Map
At first glance the map portrayal of Access to dental care was
deceiving….
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Looking for Need and Disparities….
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Mapping “Dental Deserts”
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Mapping Dental DesertsDefinition: Areas in LA County that meet all 3criteria:
1.Areas with high population density; AND
2.Areas of low‐income AND
3.Areas that have no or insufficient dental services.
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Methods/Sources of Data:
• Maps were created with GIS showing where each facility is located in the LAC area.
• Data provided by the 211 LAC Hot Line, • My Health LA Database, • HRSA data on FQHC, and • City population data was gleaned from the U.S. Census. (Source: 2015 ESRI, Arc GIS)
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NB10
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Slide 23
NB10 should this go before the map slides? I think it might help to explain this before you show the maps.Noel Barakat, 3/16/2016
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Mapping Dental DesertsDefinition: Areas in LA County that meet all 3criteria:
1.Areas with high population density; AND
2.Areas of low‐income AND
3.Areas that have no or insufficient dental services.
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High Density Population:
• Clear definition of population density, but not of “high” density. Population density is the total number of people within a defined area.
• Since the 10 most densely populated cities in the US have an average population density of > 10,000 people per square mile, we used that number as the definition of “high” density.
http://www.governing.com/blogs/by‐the‐numbers/most‐densely‐populated‐cities‐data‐map.html
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Mapping Dental DesertsDefinition: Areas in LA County that meet all 3criteria:
1.Areas with high population density; AND
2.Areas of low‐income AND
3.Areas that have no or insufficient dental services.
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Deciding Low‐Income Population:
• If you make less than 138% of the Federal Poverty Level, you qualify for Medi‐Cal.
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Household Size 100% 133% 138%
1 $11,880 $15,800 $16,394
2 16,020 21,307 22,108
3 20,160 26,813 27,820
4 24,300 32,319 33,534
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Mapping Dental DesertsDefinition: Areas in LA County that meet all 3criteria:
1.Areas with high population density; AND
2.Areas of low‐income AND
3.Areas that have no or insufficient dental services.
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IS THE NUMBER OF CLINICS AND DENTISTS SUFFICIENT
FOR THE DEMANDS OF THEIR CATCHMENT AREAS?
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What’s the acceptable ratio of dentists to patients?• Centers for Medicare and Medicaid Services recommended ratio of 1 provider for every 1,500patients.
• California Office of Statewide Health Planning and Development defines a geographic area:– Overutilized if the ratio of 1 provider for more than 3,000 patients
– with unusually high needs: ratio of 1 provider for more than 4,000 patients
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• Each dental clinic has an average 2.5 providers
• We will use the Fed’s definition of an unusually high needs: ratio of 1 provider for more than 4,000 patients.
• So each clinic’s catchment area can serve 10,000 patients.
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Findings:
We found areas which clearly fall within our definition of Dental
Deserts based on high‐density, low income, and inadequacy of dental
services.
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Compounding the currentproblem of
Dental Deserts…
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The number of dentists per capita have decreasing over time.
Additionally…
Data Source: AHRF (HRSA/BHPr)http://www.healthindicators.gov/Indicators/Dentist‐rate‐per‐100000‐population_130/Profile/Data
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Ratio per 1,000 residents– Trend in Los Angeles County
2008 2010 2011 2012 2013 2014
0.873 0.726 0.743 0.759 0.777 0.739
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UCLA Center For Health Policy Research Policy Brief
• Dentists Moving out of State: 4% in 2008 up to 14% in the current survey.
• Dentists Nearing Retirement: Many dentists in the state are nearing retirement.
• Specialization: More and more dentists are leaving general dentistry behind to become a specialist. In 2008, 6% of newly licensed dentists were specialists, up to 13% on 2012.
March 2014 Trends in the Supply of Dentists in California
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Next Steps:• Contact the CA Department of Health Care Services (DHCS) to obtain information regarding fee‐for‐services providers that are actually billing for dental services.
• Engage medical FQHC that could be our potential partners for areas that are truly underserved.
• Expand the loan repayment program (HPSA) to the Dental Deserts to attract additional dentists.
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Conclusion/Learned Lessons:• GIS maps are ideal tools to illustrate the distribution of dental services and should be a standard tool when planning delivery of dental services and analyzing access to care.
• Must be careful to analyze every data set and scrutinize the results in a careful and unbiased manner.
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Acknowledgements:
• California Dental Association (CDA) :
Colin Branson, Customer Insights Analyst, MarketingGayle Mathe, RDH, Director, Comm. Programs, Public Affairs
• LAC Department of Public Health:
Noël Bazini‐Barakat, RN, MSN, MPH, Nursing Director, Bureau of the Medical Director
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4848
Questions